Provider First Line Business Practice Location Address:
2517 NW 65TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98117-5835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-345-0564
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2016